Making Homes For All Ages


How can a small, tired house be remodeled to provide for a family of all ages is a question many people face but few people know how to make a reality.

That’s because while this approach towards improving the functionality of a home while maintaining its appeal is known as universal design (UD) and much attention is justifiably paid to including UD features in new home construction, many people don’t know they can do some simple things to make their home more ageless.  It is true that in new homes, the added cost is minimal and the integrated UD features accommodate almost any home style. But we can’t rely exclusively on building our way into better homes for our 21st Century demographic. There are so many old fashioned existing homes in the US, we need to address how remodeling can play a role in upgrading the function of already-built housing.

The Home Today, Home Tomorrow Design Challenge home, in Memphis TN provided a number of solutions to this challenge. While few of us can attempt a total home remodel (all at once, at least), there are many individual features that are within most of our means. And over time many of us can address one home feature after another until cumulatively, we may have created a much more livable home that can serve our family and friends throughout all of life’s changes.  Read on below, and also check out other interesting features and designs highlighted in the Challenge’s Toolkit.


The interior and exterior functional improvements to the home are fully integrated. Most of them would never be noticed as conveniences, just nice elements.

The front of the house features seamlessly integrated elements of universal design. A key UD component of any home is at least one step-free route into the house. Our Design Challenge home has step-free routes to three entry doors as well as a route from the driveway, to the backyard and back patio!  Someone can walk or roll from the driveway to the front and side decks.  Gardeners can reach the raised planters easily. The front entrance is level with the first floor and is protected from the elements by the porch roof. So, the family is protected from sun, rain, or snow when entering or exiting.


The rear patio continues the level deck, the step free entrances, the protected entries, and the raised bed planters that reduce bending and stretching when tending the plants.


In the now opened-up interior, the entry flows into the living room of the home with wider hallways and doorways as well, allowing the free movement of people. All floors are hard surfaces that are easy to clean, and easy to walk or roll across. Area rugs such as that seen in this image can always be added or removed as needed.

As we look across the entryway on the left we see a multipurpose room with multi-height storage and a murphy bed behind the wood double doors. Moveable walls can be selectively opened and closed with minimal effort. With the walls closed, the room can be used as a bedroom or guest room. When opened, as in this image, it can be used as semi-private space for sitting, reading or for home work. Open walls also allow for visual connection into and out of the room, for instance a real benefit if someone has to remain in bed for long periods.  Higher electrical outlets and lower light switches in the house suit all heights of occupants in the home. Finally, lever door handles make opening the doors simple, even if your hands are full.


Adequate lighting is an important universal design feature, especially in the kitchen preparing food in the kitchen. This home’s mix of natural, recessed, pendant, and under-wall cabinet lighting ensures that occupants of any age will have the light they need. Adjustable window covers ensure that over-lighting and glare is minimized. Multi height work surfaces allow for people of different heights to enjoy working and relaxing in the kitchen. Lever handle hardware on the kitchen sink allow users ease of use.


Pull out shelves and multi-level drawers in the kitchen base cabinets bring storage to the user. This ease of access reduces bending and reaching to get stored items. Items can also be more easily seen.


A useful feature of a universally designed home is a curbless shower, a shower floor that is level with the floor of the bathroom. The shower in this home has a large frosted glass window, which provides even natural light to the whole bathroom. The adjustable shower head allows use by tall or short users. The shower seat can be used for sitting or just resting a foot on for washing or shaving. Not seen is the blocking behind the walls for easy installation of grab bars later, if needed.


With just one full bathroom in the house, a two-height vanity accommodates tall and shorter family members.  A hidden feature that some families may like is that the lower base cabinet can be removed for seated users. Both sinks feature lever hardware for easy operation.

Meeting the Home Today, Home Tomorrow Design Challenge


We are all aging, which is a beautiful thing. But more than adding numbers to our age, we are getting older, which means adding more years of experience in this beautiful world. Along with this experience should come a recognition that we will be at a disadvantage with only blind trust in an easy future. Aging and getting older have to be met with a sense of wonder and preparation, especially when we consider that more than 30 percent of all Americans will end up in a nursing home in the later years of life. Many could avoid this outcome by preparing their homes and their environments early, in anticipation of changes that may come with each passing year.

When we think of home, we think of the place we feel most nurtured and at peace. But when certain aspects of a house or apartment go unaddressed, even a small physical handicap or prolonged illness can turn into a deal-breaker, making it impossible to live in the place we want to live. Ninety percent of all Americans want to age at home – and fulfilling that wish is possible, but only when we prepare early and rethink architecture and neighborhoods at once. This is why the Home Today, Home Tomorrow Design Challenge is such a milestone. The competition invited architects and designers from around the country to redesign a typical suburban home in Memphis (one that was designed for the young and healthy only) into a home for all ages. As an architect and a longtime advocate of design for all ages and abilities, I have learned that a home that supports our physical and social well being will very naturally evolve for us over time. For example, if we cannot get out of bed, we should be able to see outdoors; if we cannot drive to see friends, they should be able to visit us easily.

The winning scheme, a blueprint for the home’s remodel, met these goals in several ways. It eliminated all stairs for safe and smooth transitions between levels indoors and outdoors, and expanded the bathroom to accommodate a wheelchair when needed. It also included all key details in terms of appropriate task heights for a person seated in a wheelchair, while taking into account accessibility and safe grab-bar placement to make cooking, eating, bathing, and relaxing possible for all ages. The design also positioned one flexible room at a strategic location: This multipurpose room can be connected with a large open door to the living room. It’s a simple move, but magical. That one flexible room can be used as an extension of the living room, as a separate home office, or as the ground-floor bedroom for a person who is in bed for an extended period of time. Proximity to the living room and views through the large doorway allow for the inclusion of a person in bedroom in the daily social activities in the house. The house itself opens up to the neighborhood with a large expanse of windows, visually connecting to the outdoors, and, even more important, creating an informal connection to the neighbors. We all know that we are stronger within a community, and such relationship needs to be facilitated and nurtured. This house design does exactly that. It breaks down walls and invites people to engage. Just imagine what a difference it will make when a neighbor swings by to say hello and help with errands without being asked. The house, an extension of its occupants, invites people inside.


The transformation of the house was not rocket science, but it makes all the difference between aging comfortably at home and the alternative of being forced to move into a senior facility that is impersonal, and away from family, neighbors, and the activity of a community. Accomplishing that it is so easy in many ways. Hopefully knowing these simple steps wakes up the masses, and urges people to take notice that they should and can remodel a house to be age-independent and supportive of its owner all life long.

But these remodels can’t happen overnight. The key is to do this kind of work in the home early, before any physical or social challenges occur, so we can live a worry-free life. An age-friendly home is a better home. Who does not want to have a home that encourages socializing with the neighbors? Who does not want to have a bigger and more comfortable bathroom? Who does not want to have a home that is safe and secure and protects us from falls. I want that – and I am 45 years old! I am honored that I was invited as a judge for this milestone competition, and my wish is that this one house opens the eyes of all 78 million Baby Boomers in this country and encourages them to review their homes and make key changes if needed. Today is the day. Start taking these steps one at a time or all at once so you can live the life you want, all life long.

Bringing Up the Next Generation: Keys to Lifelong Health Lie at Home


Growing up in California, my own early years were not perfect, but by most standards, I had a rather idyllic home life. My parents were loving and devoted to making sure I had what I needed. Our neighborhood was safe, full of families, physically attractive, and provided close by opportunities for safe play, fun outings, and access to good food, good schools, and needed services. And for me, as a child, I felt supported, safe, happy, and free to learn, grow, play, and explore. As a young child even, to me it was a no-brainer: every child should have the same chance to thrive that I did.

And yet, even as a child in elementary school, I was aware that many of my friends didn’t have the same chance at the idyllic childhood home that I held so dear. Some of my friends moved a lot from house to house because their families struggled to afford their homes. Others lived in a house that was full of love and stability but were placed in neighborhoods full of violence, danger, or other uncertainties.  My internal sense of justice, even then, drove me to wonder why such inequities existed?  Why every child growing up in my town didn’t have access to some of the key ingredients that make home all it can be, why instability and poverty and hardship and violence marred their childhoods.

My passion for improving the lives of children and fighting for justice and equity are things I found early in life. And they drove me to pursue a career as a pediatrician and public health researcher. Through my training and research, I now understand the data and research that supports the sense I had as a child that what happens at home has tremendous impacts on how children feel, how healthy they are, and how much they and their families can thrive.

In fact, there is no question that the impact of home goes beyond what happens inside the four walls of the physical space where families live. When I think of home, it is an amalgamation of family, house, neighborhood, and community. It is the place and the people that surround and shape our daily lived experiences. For a small child, this sense of home is almost their whole world.

And research strongly supports the notion that what matters for young children goes far beyond the four walls of their physical home. In my clinical practice, I am constantly reminded that parents care deeply for their children, and despite their limitations, they want their children to thrive. And children are incredibly resilient despite life’s challenges. But there is little question that early adversities shape the health of each generation. And many adversities happen at home.

Inequity in health outcomes are persistent and longstanding. Furthermore, these health outcomes are driven by far more than health care. In fact, access to health care and biology are not the sole determinants of health. Environmental and social factors are critical. The places where children live, learn and play have lifelong health consequences.

We know that, in adulthood, people from certain minority groups and those living in poverty have higher rates of premature death and chronic disease including cancer and cardiovascular disease. But the risk factors that produce these health inequities don’t just arise after a person’s 18th birthday. In fact, the conditions in which children live, learn, play, and grow impact their health for life. And what happens at home matters. Toxins or safety hazards in the houses where children live, concentrated poverty, racism, violence, and lack of access to good schools in the neighborhoods and communities where children are reared all play a role. Inadequate access to safe places to play, good food to eat, and lack of access to good jobs and economic opportunities and social supports and services for parents and caregivers can all have negative impacts on the health of children and contribute to mental and physical health problems in childhood and can set children up for long-term health issues that manifest well after their 18th birthday.

In the U.S., a land of plenty, child poverty is a growing epidemic. Over the last few decades, childhood poverty has risen from 14 percent to 22 percent. One in five children in the United States lives in poverty.  Most of my patients live in Baltimore City, MD, where the picture is even bleaker: one third of children here live in poverty (also, sourced). And poverty doesn’t just affect individuals or families. It affects neighborhoods, communities, and the full totality of a child’s home.

Impoverished families live in impoverished communities which lack the economic resources and access to basic goods and services that support good health. The cumulative effects of poverty, and the chronic stress that goes with it, are highly corrosive. They fuel a child’s risk for post-traumatic stress disorder, depression, anxiety and a range of other mental health problems. Such chronic stress can overwhelm a child’s coping responses. In the short term, it leads to behavioral, mental health, and academic problems. Over the long run, it impairs proper immune function and can precipitate the onset of devastating disorders including mental illness, substance abuse, cardiovascular disease, hypertension and diabetes.

The human price behind these grim statistics is staggering. The research is unequivocal: early-life stressors exact lifelong, insidious damage on health. Children who grow up in poverty face more threats to their life-long health: higher rates of acute and chronic illness, more frequent hospitalizations, worse developmental and academic outcomes, more substance abuse, worse mental health and higher death rates.

Helping families find gainful employment and providing children with a safe living environment, violence-free public space, access to healthy food and good education is our moral imperative. It is also a wise socio-economic strategy, one that will ensure the long-term viability of our city and, indeed, our country.

That journey begins by rebuilding our neighborhoods and by insuring that every child has access to a home that is safe, nurturing, and surrounded by the resources and supports that promote children’s optimal development, support the health and well-being of children and parents, and optimize the landscape of economic opportunity so that parents can realize their deep desires to provide a good life, a safe place, a loving and nurturing home for their children to grow and thrive.  Bottom line: Home Matters.

A Lifetime of Homes: Lessons from a Career in Housing Policy


I am often asked, after living in various homes for fifty years and studying homes for roughly half that time, whether I think that America’s housing situation has gotten better over the years. The short answer is, I do not.

The long answer is a bit more personal.

I moved into the first house that felt like home when I was eleven years old. It was a two-story colonial that my parents bought in the suburbs of south New Jersey. They were a black couple in a mostly white neighborhood circa 1977, and they were scared. One reason for fear was obvious. This being only nine years after Martin Luther King Jr. had been assassinated, we knew there was a reasonable chance that we would not be welcomed and accepted, let alone treated fairly.

The other reason for fear was the risk of financial ruin. Like so many African-American families in the 70s, my family did not have a large nest egg or a wealthy relative to draw upon when buying their home. Instead, they stretched their resources to realize something they only dreamed about when they were growing up: owning a home and living the American dream.

It’s hard to say exactly what it is that makes a place a home. For my parents, it was partly that they wanted their children to go to good schools.  Jobs were another reason for the move. My father was an engineer for Seagram’s, and my mother worked in advertising at Rohm and Haas, and our house was relatively centrally located to both offices.

Overall, though, my parents understood what I have only progressively come to understand over a career of research and policy development: housing is a platform. It is not just a building or even a city block. As I have shown on this blog over the past year, housing lies at the very heart of our health, our education, our economy, our public safety, and our individual success.

By these measures, our homes have failed far too many of our citizens.

We’ve met many of these citizens on this very website. There were the elderly whose homes didn’t allow them to age in place without suffering worsening health outcomes. There were the middle-aged white Americans who were increasingly turning to drugs and suicide when they lacked the resources and support system to sustain their mental health. There were the children exposed to toxic levels of lead in their water and paint. There were the low-income families who couldn’t complain about substandard housing, lest they risk eviction and homelessness. There were the young students whose communities didn’t equip them for educational success. There were the older students who couldn’t afford the basic housing they needed to succeed in college. There were the victims of concentrated poverty, trapped in dangerous neighborhoods that stressed and damaged their residents. There were the unsophisticated borrowers, preyed upon by predatory lending, and the especially cash-strapped households, who couldn’t find affordable credit anywhere. And, of course, there were the black Americans who were prevented at every turn from accessing the wealth accumulation vehicle that built the middle class: homeownership.

These are the people to whom I and many of you have dedicated our life’s work.

I remember the home where I first found this purpose in my career. I was living in the Noe Valley, which was transitioning at the time from a working-class neighborhood into the more affluent community that it now is. I’d finished classes at Stanford, and I had just started working on my dissertation when I moved in. It wasn’t like the suburban neighborhood I grew up in. So many amenities were within walking distance, with more popping up every month. The storefronts were changing before my eyes. It was the first time that I began to think deeply about accessibility—and all the things I had access to that most Americans did not. I started researching mortgage lending, and I began to see that housing wasn’t just an end in itself. It was a means—an instrument to a way of life—and that made it so much more valuable and essential.

From San Francisco, I moved to Washington DC, where I lived on Capitol Hill. This neighborhood too was in transition, but it was further along than Noe Valley. It already had all the amenities I needed. I saw how a community could be self-sufficient, and I realized just how dependent most communities were on factors outside their control. At the Federal Reserve, I began researching community banking to understand how we could give communities the resources to shape their own destiny.

We sold the house I grew up in after my dad passed away. My mom still lives in the area, but this new house never quite feels the same as the one I grew up in. There’s always something special about that feeling you get when you’re home. You can’t fake it or replace it. You can’t even define it. But you know it’s where you’re meant to be.

It’s such a powerful experience that I’m always surprised we don’t spend more time talking about it. We spend more time at home than any other place, and yet we hardly ever hear our politicians utter the word “housing,” even when they explicitly campaign on the “American dream.”

The funny thing is, for all we idealize it, I don’t think there is such a thing as one American dream. I think we each carve out our own individual dream. I think that’s what it means to live in a free nation. When Thomas Jefferson first envisioned “life, liberty, and the pursuit of happiness,” he was rejecting a European social order based strictly on lineage, rather than choice. Thus, he said, we must be free to move and trade and live where we feel truly home.

The other question I am often asked is whether I am optimistic that America’s housing situation will get better in my lifetime. The short answer is, I think it can, and I will fight everyday to see that it does.

The long answer is, well, up to us together.

1968 Memphis Home Will Be Remade Into a Flexible, Sunny Haven


As a result of the Home Today, Home Tomorrow design competition, a house in Tennessee will be fully retrofitted for a veteran family.

The “Re-Defining Home: Home Today, Home Tomorrow” competition invited architects and designers around the country to submit plans to renovate a home in Memphis, which will be gifted to a veteran family this fall. Hosted by Home Matters, AARP, the AARP Foundation, and the Wells Fargo Housing Foundation, the competition asked entrants to design a structure that accommodates aging-in-place and incorporates Universal Design principles, as at least one member of the receiving family will be over the age of 50. The budget for the remodel was $75,000.

The three winning design teams were announced today. The first-place prize goes to Gabriel Espinoza, Carmen Velez, and Timothy Gargiulo, three junior architects practicing in New York City. Their proposal will be integrated into the home, and the renovated structure will be unveiled in November 2016.

The existing dwelling featured a number of small, cramped rooms and tired finishes. Far from accessible to a person of limited mobility, the layout presented a clear challenge to the entrants of the competition to create a more dynamic spatial flow. Another obstacle: the house was only accessible via several steps up to the front door, meaning that if a resident required a wheelchair at any point in the future, they wouldn’t have a way to enter their home. The point of the challenge was to come up with a flexible design solution that wouldn’t require extensive retrofits down the line, ensuring that the residence would be a comfortable place for a family to live for the long haul.

Get a glimpse of the winning submission below, and head to Home Matters for more details about the first, second, and third place entries.

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The winning design highlights community interaction. Planter beds in the front yard not only give the residents the opportunity to take up gardening (a hobby with proven benefits for the elderly), but the garden also has the potential to become a communal space that invites neighbors’ participation.

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The main intervention proposed by the winners is a glass addition on one end of the structure; along with introducing ample natural light, it also further connects the residence to the neighborhood. A deck with outdoor dining tables flanks this glass room, and a carport provides sheltered parking off the street.

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By changing the grade of the site, the architecture team eliminates the need for steps, so the entrance to the house is flush with the front yard.

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Additional garden boxes are installed off the rear facade. Photovoltaic panels top the carport, allowing future cost savings for the residents.

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In addition to the exterior sun screens, interior shades can be lowered to limit exposure and visibility when desired.


In the video above, hear how the winning team came up with their proposal.

How to Capture on Film All That Home is About…in 60 Seconds or Less


As a student I got to know a man called Frank. He had lost his home, and his neighborhood, and was living on the streets and shelters. He wanted to go back to a world where he had a family, a community. Yet he had no hope. His story of yearning to return home stayed with me for years.

I thought of Frank and his family when collaborating with Home Matters, a coalition that envisions a future where all of us have a home.

It seems simple. Home should be a given. Home is where you grow up. It is the place where you are nurtured, thrive, spend time with your family and community. A home is what you need for health, safety, and success in life.

These days, however, too few of us have a home like that. Some quick facts:

  • More than half a million people are homeless.
  • 55% of all Americans are making big sacrifices just to pay their rent or mortgage.
  • Thousands of communities lack good schools, parks and grocery stores.

These statistics are particularly striking because home is woven into our national mythology: owning a home is part of the American Dream. Of course, economic changes and globalization have made this dream no longer attainable for many.

Home Matters didn’t come to us saying that everyone needs a single-family home with a white picket fence and a four-door Ford out front. Their dream is different. They think no one should have to choose between food and shelter; that no one should have to live in sub-standard housing, attend a school without school supplies or attention, or eat unhealthy food; that no one should have to sacrifice everything just to put a roof over their head.

That dream sparked the idea for a short video series for their new #OpenTheDoor campaign.

Our challenge from Home Matters was to create a spot that would get people to rethink the idea of home—to understand what it really means. Home is more than shelter. Home includes your house or dwelling, your school, and all your local resources. How do you convey all the ways home matters in 60 seconds? In 15 seconds?

We created three short films: “American Dream Dollhouse,” “Foundation,” and “Sacrifice”. In “American Dream Dollhouse” we sought to make clear the stark contrast between what every child dreams of – a safe home in a loving community – and the reality now faced by the majority of Americans. We used stop motion animation to instill a sense of childlike wonder and curiosity in our viewers, and prompt them to keep dreaming.

Home Matters still

Above all, we wanted the pieces to convey our hope that together, we can build a better future. A hope that this New American Dream can still be within reach – that a safe and steady home can be made accessible to all. Because Home Matters too much to settle for anything less.

Substandard Housing: The Choice No American Should Have to Make


I heard a story recently about a man who lived in a crooked apartment. The floor was sloped, so that if you placed a bottle at one end of the room, it would roll downhill until it hit the other wall. The apartment was rent-controlled, and the man who lived in it was terrified that rent control would go away because if it did, he was convinced the landlord would fix the floor so he could raise the rent. The man liked the fact that his apartment was crooked because it was the only reason he could afford to live there.

It’s all about tradeoffs. We can’t all get what we want. So we make sacrifices. For some of us, maybe that means we can’t have the big house with the backyard. For others, it’s a flat floor.

For Lamar, it was clearing maggots out of a kitchen. Lamar and his two sons were looking for an apartment on the North Side of Milwaukee when the sociologist Matthew Desmond caught up with them for his new book Evicted. When Lamar finally found a two-bedroom place he thought he could afford, it had “maggots sprouting from unwashed dishes in the kitchen.” He took it. “I’m blessed,” he said.

It may surprise you that flat floors and maggots in kitchens are tradeoffs facing Americans seeking affordable housing today. Aren’t there building codes, you ask? The answer is yes. A few generations ago, we decided to draw the line at certain basic requirements every home should have. But a complete answer goes beyond that and gets a bit complicated.


The first building codes date back to ancient times, when a contractor could be put to death for building a house that collapsed on its owner. More recent regulations evolved out of citywide disasters like the Great Chicago Fire in 1871 and the 1906 San Francisco earthquake. These precautions protected residents from dangers they had little expertise to prevent on their own.

The regulations that are supposed to protect people like Lamar, however, weren’t adopted until the mid-twentieth century when Congress made it a national priority to eliminate substandard housing in the major cities. And in the years following this focus, the extent of substandard housing decreased dramatically. The number of homes lacking heat and indoor plumbing has fallen sharply. The incidence of lead in the home has similarly declined in significant ways.  So we have seen progress, especially in rural areas.

But here is where we come back to tradeoffs, because there were costs.  Many of the so-called “urban renewal” efforts that drove a part of the change involved slum clearance and neighborhood “reclamation” efforts that resulted in widespread displacement of poor families from their homes by force. Within these communities, urban renewal came to be known as “Negro removal.” For many residents, the experience was so traumatic that their resentment continues to this day.

Further, in spite of the progress we have seen, the past is not entirely past. Just ask Arleen and her sons Jori and Jafaris. When they first entered Desmond’s story, they were living in a homeless shelter. Then they found a house. The original coat of paint had almost completely disappeared from the exterior, and a new coat covered less than half the house before the painter, apparently, gave up.

“There was often no water in the house,” Desmond writes, “and Jori had to bucket out what was in the toilet. But Arleen loved that it was spacious and set apart from other houses. ‘It was quiet,’ she remembered. ‘And five-twenty-five for a whole house, two bedrooms upstairs and two bedrooms downstairs. It was my favorite place.’”

The usual response to substandard housing is to get the people out of the poor living conditions. Nobody should be living in a place with maggots or toilets that don’t work.  Indeed, this is what happened to Arleen after only a few weeks of living in her “favorite place.” The city designated her house “unfit for human habitation” and made her vacate it.

The problem is that eviction works in this case only if there is another unit above the minimum standard that is affordable to the family forced to move. And the narrative from Evicted shows that there often isn’t one.  In these cases, all eviction does is move a low-income family from one substandard home to another.

Sadly, I fear this problem is only going to get worse.  The housing stock is aging. In most large cities, rents are becoming increasingly unaffordable. Many cities are restricting construction of housing that could meet the needs of a growing population. As demand outstrips supply, it’s inevitable that more and more families will fall into this vicious cycle, unable to afford anything other than substandard housing.

If we accept this premise, we are left in a tough predicament. Because enforcing building codes improves the quality of rental housing, it will have a negative implication for affordability.  Every homebuyer knows that quality and price are inextricably linked, and this is true in the rental market as well.

The implication is that we can’t think about building code enforcement without also thinking about and addressing affordability.  For too long, public policy has treated them as separate problems. And it has left people like Lamar and Arleen to fend for themselves and select from the worst that our housing has to offer.

Housing policy must embrace this mandate—to banish substandard housing without banishing the long-suffering residents trapped in its sinking clutches.  Because there are certain tradeoffs no one should have to make. It shouldn’t be too controversial to say that everyone deserves a home with running water, no maggots, and a flat floor. A quality home should not be out of anyone’s price range.

The Flint Lead Poisoning Disaster: Why We Must Invest in Healthy Homes


About 150 years ago, people figured out that lead pipes could kill them. In 1861, fifty prisoners in King County Jail in Brooklyn started vomiting uncontrollably, until a doctor realized that the water supply was contaminated with lead. Seven years later, a New York City woman named Elizabeth Galler was accused of poisoning her husband to death, until the coroner concluded that the lead in his body came not from one big dose, but rather from many small doses over a long time. The New York Herald ran an editorial demanding an investigation into the city’s lead pipes. We now know that the lead level in New York tap water back then was over 100 times more toxic than the EPA’s current standard.

The economic historian Werner Troesken tells these stories in his 2006 book The Great Lead Water Pipe Disaster to make a point: This is an old problem. But sadly it is not one that has gone away. This is one lesson to take from the events unfolding in Flint, Michigan, where an entire town has been drinking contaminated water since March 2014. The stories of nauseating brown water and blasé state officials paint a shockingly distressing picture of mismanagement and neglect. 

Unfortunately, in America, the lead problem is not limited to Michigan. Instead, it extends far beyond Michigan. If 4 percent is too many kids to have high lead concentrations in Flint—and it undoubtedly is—then what does it say that it’s 12.9 percent in Milwaukee and 17.6 percent Cleveland? Or, can you believe it, 40 percent in Claiborne Parish, Louisiana, and 58.3 percent in Houston County, Alabama?

To be fair, tremendous progress has been made on the public health front, and much of this progress has been in the area of healthy homes.  For example, the number of people living in substandard housing has fallen by almost half since 1978, and we now have less than 1 million units in this condition, with many of these units in rural areas.

We have even made considerable progress where lead exposure is concerned.  Between 1976 and 2006, the incidence of lead in blood among children under 5 fell dramatically, from 13.5 million to 174,000. So we are a long way from the days when 85 percent of big cities used lead pipes and 10 percent of Massachusetts residents suffered from lead poisoning.

But 174,000 kids exposed to lead is still far too many, so our work continues in programs across the country actively working to minimize lead exposure. In Milwaukee, researchers have been tracking children’s blood lead levels and found them improving from the city’s lead hazard control program. In Rochester, the city’s housing inspection law has made thousands of homes safer from lead paint. In Boston, the National Center for Healthy Housing has reduced outdoor lead contamination with low-cost soil interventions. Throughout the nation, the Department of Housing and Urban Development has issued grants that reduced lead contamination in homes and improved children’s health.

This is all good news.

But a second lesson I am reminded of from the Flint case is that poor people often bear the burdens of environmental degradation.  Companies have a long history of locating their most pollution-intensive plants closest to the poorest neighborhoods, making life harder for the Americans for which it is already the hardest.  Experience shows that maintaining reduced lead exposure in such at-risk communities is especially hard. The HUD intervention, for example, cleaned out the lead dust in the short run, but a year later, it piled up again. Home maintenance requires constant vigilance.


One look at Flint is all it takes to see how communities deteriorate without sustained investment. Cost-cutting becomes a dangerous temptation. In Flint’s case, they had to cede power to a state-appointed “emergency manager” who made the ill-fated switch to a cheaper water system. As one Flint resident pointed out, there’s no mystery why they got stuck with this penny-pinching czar: “Almost every city that got one was a poor, African-American-majority city devastated by a shrinking industrial sector: Flint, Pontiac, Detroit, Highland Park, Benton Harbor, and so on.”

What does all of this say? It says that healthy housing matters. It says that healthy neighborhoods matter. And it says that for all our progress—let’s not forget that those percentages have fallen significantly in recent decades—we are still allowing too many American kids to be poisoned. Usually, of course, it’s the kids who are already starting at a disadvantage, coming from poor homes and segregated neighborhoods.

It’s definitely progress that Flint shocks us. In Elizabeth Galler’s day, there was no outrage over the lead pipes that killed her husband. We have come to expect more from our cities because our cities have shown that they can overcome these threats to our health.

Our homes, above all else, should not be threats. They should be the one place where we—and our children—can feel safe. But safety does not come free. It requires a commitment by all of us to invest in the programs and policies that can condemn known, predictable threats like lead exposure permanently to the past where they belong.


What If Your Home Today Can Be Your Home Tomorrow? Forever.


Starting a family or preparing for retirement are large life transformations – ones that often involve the turmoil of changing homes, neighborhoods, and communities. But what if that wasn’t the case, and you could stay in your home and community, no matter what changes life throws your way?

That’s the ultimate goal of The AARP, AARP Foundation, Home Matters and Wells Fargo Re-defining Home: Home Today, Home Tomorrow design competition – we’re challenging architects, designers, and allied professionals to come together as interdisciplinary design teams to create new standards for housing in America that enable people to stay in their home as they travel through life’s various stages.

By leveraging universal design solutions to remodel an existing home located in Memphis, Tennessee, participating design teams will demonstrate attractive, adaptable, affordable, and replicable design elements that address and showcase livability by promoting aesthetic and functional designs for better living.


Coined by architect Ronald L. Mace, a Fellow of the American Institute of Architects, universal design embodies designing a built environment to be aesthetic and usable to the greatest extent possible by everyone, regardless of their age, ability, or status in life.

While the phrase “universal design” may conjure images of barrier-free design staples (like ramps and grab bars), that is not the goal of this design competition. The guiding principles of universal design go far beyond accessibility issues. Remaining essentially invisible in order to assist in a seamless transition between life stages, including entering the workforce, building a family, coping with an empty nest, and discovering new passions after retirement, universal design principles take into consideration the needs of its homeowner at every stage.

Jar Opener

When envisioning universal design, think OXO kitchen products versus grab-bars. OXO is a well-designed, well-known product line specifically founded on the philosophy of universal design, designing products for young and old, male and female, left- and right-handed, as well as those with special needs. With its debut of 15 kitchen tools in 1990, OXO set a new standard by creating effective, attractive tools that people of all ages and abilities were proud and eager to use. Now, that’s what we’re trying to achieve with the Re-defining Home: Home Today, Home Tomorrow design competition.

Are you ready to make the change in your own home? Easy-to-use, accessible, affordable products and services improve the quality of life of all citizens. But given a multitude of options, materials, evolving technologies and trends, how do you know what is right for your home and your family?

Involving an architect or designer at the earliest stage in project planning can allow for a better opportunity to analyze your needs, develop effective solutions, and propose ways to keep costs down. With a broad understanding of design and construction, an architect or designer can help guide you through the entire home renovation or building process, offer new ideas, and help you create your very own forever-home in the most efficient and effective manner.

This invaluable expertise and perspective that an architect or a designer contributes to the design and building process enriches how we experience the built environment and its connection to our everyday surroundings.

AIA San Francisco and its members are proud to partner on this important challenge. Our members from around the Bay Area are at the forefront of design and develop housing for all types of individuals and families. We’re looking forward to see what the architect and design community, and members of our 30+ partner organizations, develops for the competition. We know that the submissions will inform and improve our work here in San Francisco, and across the country, so that a home today can be a home tomorrow.

Good Home + Exercise = Good Health


As a middle-age woman, I decided to go back to school and become a nurse because I wanted to help improve the health of those around me. While attending college, the responsibilities of work and school greatly increased. I found myself with less free time to cook healthy, homemade meals and less time to do physical activities with my children. After graduation, I found that my family and I were heavier and our overall health had declined. I was not only concerned, but I also felt embarrassed that I had not done anything to prevent it. As a nurse and a mother, I feel obligated to teach about the prevention of diabetes and search for resources in my community to help not only my family, but also others in my community, live healthier, more active lives.

One in ten adults has diabetes type 2. In the United States, the number of cases of diabetes has increased significantly in the last few years, especially in children. Through my research and experience as a nurse, I have realized that specific ethnic groups and families with lower incomes are affected the most. Lack of exercise is one of the main reasons for the increase in the number of cases of diabetes. These low income-communities do not have the resources necessary to keep families active and to prevent diseases.

Diabetes is the root of many chronic diseases: renal, hepatic, cardiac, and gastro-intestinal diseases, as well as amputations and other metabolic complications. Many of these medical conditions could be prevented by providing resources in the community, teaching children about healthy foods choices, and promoting the physical activity.

I volunteer for the local fire department and I have learned that members of low-income communities lack access to proper preventive health care. These deprived populations are bombarded with cheap junk foods that are sold in restaurants, food stores, convenience stores, and even in auto-parts stores. These communities do not have access to grocery stores that many of us take for granted, offering healthier meal options that include grains, lean meats, fresh fruits, and vegetables. Another factor affecting these communities is the lack of affordable child care programs. Most of the parents work long hours and children are left home alone. Kids spend long hours watching television, playing video games or using the computer, and eating only accessible junk food without the option of eating healthy, homemade meals. These home situations are not only unsafe, but also increase their risk for diabetes and obesity.

Communities like these need safe environments, parks, and recreational facilities for children to play. They also need school programs that offer exercise and opportunities for social interaction. It has been proven that an increase in healthy food environments and opportunities for physical activities are associated with a lower number of cases of obesity and diabetes. Scientists from Harvard University have discovered that when a person exercises, our muscles release natural substances that help relax blood vessels, lower blood pressure, reduce bad cholesterol (LDL), lower glucose levels in the blood, lower insulin levels, and reduce inflammation. All of these functions protect against heart disease, stroke, diabetes, and even some types of cancer.

in uniform

To promote healthier lifestyles, more awareness is needed, as well as educational interventions with community-based approaches.  I feel fortunate to have received my education and live modestly. I would like for other families to be able to do the same – to go to college or afford to send their kids to college, to own their homes, and live in a supportive community, which provides resources to advance economically, academically, and where their children can grow safe and healthy. There is so much that could be done, but for now I will begin by preparing healthy meals for my loved ones, by teaching family and friends about diabetes prevention, and by spending more time playing and exercising with my children. I have realized that I enjoy walking with my daughter. We like to go shopping together and we talk about healthy options. We also do games at home to see if she can combine different ingredients to create a well-balanced meal and proper size portions. All of these are factors have helped me help my family prevent obesity, diabetes and other diseases.

There are several  good resources for exercise from the American Diabetes Association about local events in the community and across the country. The name of one of the programs is “Step Out. Walk to Stop Diabetes,” a great way to learn more and stay healthy. 

Hospitals also provide several resources and opportunities for healthy lifestyles. For example, in my community, Banner Health Hospital provides resources for families to stay active through their program “Go Kids!”.


And nationally, first lady, Michelle Obama created the “Let’s Move Program,” which provides information and resources to help lower or prevent obesity by teaching individuals and families to make healthier eating choices and staying physically active. I seriously believe that if communities do not provide resources for their families, activities for children, and safe living environments, these communities will never improve.

I will not give up on my children, on my family, on my community, nor on my own health. Together we can all make the difference.

A Matter of Life or Death: How Better Homes Make Us a Healthier Nation


Middle-aged white Americans have been dying at an accelerating rate for the last fifteen years. This is surprising to, well, pretty much everyone. Perhaps you heard it on the news. Almost immediately after winning the 2015 Nobel Prize in economics, Angus Deaton and Anne Case dropped this bombshell finding in the Proceedings of the National Academy of Sciences. And the nation, appropriately, was alarmed.

Now, the first thing I should say is that I’m not an expert on death. I’m not a clinician or even a health policy expert. But from my career in housing research, I can tell you something about death that hasn’t often been reported in the news: Where you live has a significant effect on how long you live.

Clarity on this issue came for me during my time serving at the Department of Housing and Urban Development. There, I spent many hours with Ron Sims, who was Deputy Secretary at the time.  Sims had worked with local leaders in King County to show that you could predict health outcomes by the ZIP code someone lived in.. He brought this notion to HUD and, under his leadership and that of the then-Secretary Shaun Donovan, the phrase “the best predictor of a person’s life outcomes shouldn’t be the ZIP code one lives in” became a departmental mantra. Sadly, today it often is. Obesity, illness, morbidity – they all vary significantly with where you live.

There were signs of trouble before the news of Case and Deaton’s research broke.

Last week, the New York Times ran an article with the headline, “Small Towns Face Rising Suicide Rates.” The victims and their communities had a lot in common. The article quoted one psychologist who pointed out that rural areas tend to have “lower incomes, greater isolation, family issues and health problems.” In fact, if you located those counties on a map published by the Times a few days earlier, you would find most of them in areas where an unusually high percentage of the population still don’t have health insurance. If you dug a little deeper, you would also find, as the Times did, “that 55 percent of counties in the United States—all of them rural—do not have a single psychologist, psychiatrist or social worker.”


A couple days later, economists at the Federal Reserve Bank of New York published a map of their own, showing the average life expectancy in each county. Aside from the choice of colors, it was nearly identical to the health insurance map. If you lived in the healthier counties, you could expect to live a full decade longer than you’d live in others.

I’ll say it again: Where you live has a significant effect on how long you live.

Housing researchers have known this fact for some time. A large body of evidence shows all the ways that your home, your neighborhood, and your environment affect your health. In the last year alone, studies have found that higher rent costs lead to worse health; more violent neighborhoods lead to higher rates of depression; moving to a better neighborhood tends to reduce obesity; more environmentally friendly neighborhoods lead to better health for the sickest residents; and crucially in light of Angus Deaton’s latest findings, we have known for over a decade that families who move to low-poverty neighborhoods experience better mental health.

Some of these objectives are economically and politically difficult to achieve, but some are as simple as building better homes. Just last month, researchers at the Harvard School of Public Health reported that people living in environmentally friendly homes were significantly less likely to experience “sick building syndrome” – dizziness, itching, and sneezing fits due to hazardous chemicals, mold, and poor ventilation.

The effects are particularly acute in children. The Harvard researchers found that kids in “green” homes were less than half as likely to experience symptoms of asthma and 75 percent less likely to be hospitalized or miss school for asthma attacks. And it’s not just green homes. Another recent study shows that kids’ brains develop better when they’re exposed to more green space and less air pollution. Yet another shows that spending more than 30 percent of a family’s income on housing can impair their children’s cognitive achievement.

These effects can last a lifetime.

In discussing the research, Deaton told the press, “Drugs and alcohol, and suicide…are clearly the proximate cause.” Note the word proximate. Drugs and alcohol don’t walk up to strangers and kill them in the street. Something leads people to drugs and alcohol, and suicide. They may be the proximate cause.  Something else is the ultimate cause.

I don’t know the underlying reason that mortality has ticked up in middle-aged white Americans. At the moment, nobody does. But I do know that these victims are not distributed equally across the country. This kind of suffering is far more pervasive in homes that lack the resources and the support system to combat the illness before it’s too late.

We can start by building better homes. And then, better neighborhoods. And eventually, block by block, a better, stronger, healthier nation.

The Challenge of a
New Century: Keeping
Housing a Home as We Age


Our homes watch over us as we age. They see everything from birth to death and in between—a child’s first steps, a beloved pet’s last breaths, from marriage to divorce, adolescence to infirmity—and through it all, they change as we change. From the decorations on the wall to the etchings on the floor, they are the unwritten diary of our lives.

Or, at least, they used to be. Today, many Americans at the end of their lives find themselves not in the homes they love, but rather in institutions they dread—assisted-living facilities, nursing homes, hospitals—and we have accepted this outcome as a fair accomplishment. We are unwitting captives in a prison of our own design.

In part, this is a result of our own success. Modern medicine has made spectacular gains. Today, the average life expectancy is nearly 80, more than double the life expectancy for most of human history. This extended lease brings new demands on the society that sustains us. And the housing sector has not kept pace.

Older homeowners typically live on fixed incomes. As a result, they spend less on maintenance and often have less access to credit. Without upkeep, their housing will deteriorate as they age. This is both dangerous and demoralizing.When these homes lose value, their owners lose wealth. On a fixed income, wealth matters. According to one recent study, when the elderly lose housing wealth, their health worsens and their likelihood of disability increases. In fact, for older populations, housing assets account for more than 90 percent of socioeconomic inequality and over half of disability inequality.

Further, with aging comes a decline in mobility. It’s harder to walk, drive, and navigate the environment. Most homes and neighborhoods aren’t equipped for this stage of life. They lack ramps, wide doorways, and bathroom grab bars. Public transit is inaccessible and inhospitable. Healthy food stores and affordable medical centers are too far away. Sidewalks are uneven and poorly lit, if they exist at all.

Faced with these obstacles, many older Americans have to choose between sedentary isolation and premature institutionalization—both of which are associated with worse health outcomes. The longer a person stays in their own home and the more space they occupy, the longer they tend to live and the less they tend to experience stress, anxiety, and depression.

In the research for his recent book Being Mortal, Atul Gawande was shocked to discover how simple changes could make such a big difference. His surgeon training told him to focus on expensive tests and medications—in short, how to stop aging—but palliative care specialists took a different approach. They prescribed better shoes to prevent falling. (Hundreds of thousands of Americans fall and break a hip every year. Almost half of them wind up in a nursing home. A fifth will never walk again.) They tried to eliminate medications that reduced the patient’s quality of life. They altered diets and routines. In short, they aimed to manage aging.

We can learn a lot from these experts. They have spent their lives thinking about an inevitability that most of us would rather ignore until it’s upon us. But by then it’s too late. And for those among us who are already facing this final hurdle—a group that will only continue to expand as the Baby Boomers retire—it is incumbent on a humane society to give them all the help and support we can. After all, we would not be here without them.


Midway through the book, Gawande tells the story of Bill Thomas, a young physician who had the radical idea to fill his nursing home with dogs and cats and birds and plants, completely outside the box that his profession had created for end-of-life care. When he ordered hundreds of parakeets, they thought he was crazy. It was a recipe for chaos.

What happened next was remarkable. “People who we had believed weren’t able to speak started speaking,” he recalls. “People who had been completely withdrawn and nonambulatory started coming to the nurses’ station and saying, ‘I’ll take the dog for a walk.’” One by one, the residents adopted the pets, and it gave them a renewed sense of purpose. They laughed and played and cared for their new animal friends.

They felt alive again.

Bill Thomas put the home in nursing home. He understood what Home Matters is all about: Our housing may change, but it should always remain a home, a place where people feel warm, safe, and valued until their very last day.

Prolonging life is one of the great accomplishments of the modern era. We need to make sure that our housing adapts to better serve prolonged lives.  

If we started designing homes with an age-in-place sensibility that allows for both aesthetics and adaptability, we would get to raise our children, become empty nesters, perhaps become widowers and mobility-challenged, yet still stay rooted to our precious memories, aging with grace, in our own home.  All the energy and investment we put into adding years to our lives is only worth it if we marshal the same effort to make those years enjoyable and fulfilling. The difference between surviving and thriving is the difference between shelter and home. For it’s only when we’re truly home that we feel that treasured presence, watching over us, sharing our journey, for as long as it’s able.